The Management of Vesicoureteral Reflux in Children with Myelodysplasia

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Abstract
Children (36) with myelodysplasia and vesicoureteral reflux were systematically treated in an attempt to control infection, eliminate reflux and preserve renal function without diversion. The reflux resolved in 9 of 21 children on intermittent catheterization and remained stable without recurrent infection in an additional 7. Cutaneous vesicostomy in 6 infants temporarily eliminated reflux in 3. Ureteral reimplantation was performed in 11 children (17 ureters) and was successful in all. Transureterostomy was done in 2 children. External sphincterotomy failed to cure reflux in 5 children. Five infants with mild grades of reflux were managed expectantly and 1 had spontaneous resolution of the reflux. Overall, this systematic approach resulted in cure in 23 patients (64%), stable but persistent reflux without recurrent infection or renal deterioration in 11 (30%), and failure in 2 (6%). No child required urinary diversion. The indications for each treatment modality are discussed.